Institute of Endocrine and Metabolic Sciences, Università Vita-Salute San Raffaele and IRCCS Ospedale San Raffaele, 20132 Milan, Italy.
Marmara University Pendik Training and Research Hospital, Department of Endocrinology and Metabolism Disease, 34800 Istanbul, Turkey.
J Clin Endocrinol Metab. 2022 Jun 16;107(7):e2843-e2850. doi: 10.1210/clinem/dgac183.
Osteopathy and morphometric vertebral fractures (VFs) are emerging complications in acromegaly. However, the prediction of VFs in this clinical setting is still a matter of uncertainty, and it is debated whether they are an early event in the natural history of the disease.
We aimed to evaluate the prevalence and determinants of morphometric VFs in patients with recently diagnosed acromegaly.
We enrolled 92 patients (43 men/49 women) on admission to the neurosurgery unit before transsphenoidal surgery, and compared them with control individuals without secondary forms of osteoporosis and pituitary disorders. We performed a VF assessment on preoperative chest x-ray images and collected biochemical, demographic, and clinical data.
We detected a significantly higher prevalence of VFs (33.7%) in patients with acromegaly than in controls (P = .001). Among the patients with acromegaly and VFs, 12 (38.7%) showed multiple VFs, and 5 (16.1%) showed moderate/severe VFs. Patients with VFs had higher random serum growth hormone (GH) levels than those with no VFs (P = .03), but there was no difference in insulin-like growth factor-1 (IGF-1) (P = .07) and IGF-1/Upper Normal Limit ratio (P = .08). Free 3,5,3'-triiodothyronine was slightly lower in patients with acromegaly and VFs than in those without VFs (P = .05). In multiple logistic analysis, GH was independently associated with risk for VFs (P = .003). The preoperative serum GH cutoff value that predicted VFs was 12 ng/mL.
For the first time, high prevalence of radiological VFs is reported in patients with recent diagnosis of acromegaly. Therefore, we can hypothesize that VFs are an early phenomenon of acromegaly and related to GH levels. VF assessment should be included in the workup at the diagnosis of acromegaly.
骨病学和形态计量性椎体骨折（VFs）是肢端肥大症的新兴并发症。然而，在这种临床环境下预测 VFs 仍然存在不确定性，并且关于它们是否是疾病自然史中的早期事件存在争议。
我们旨在评估近期诊断为肢端肥大症患者中形态计量性 VFs 的患病率和决定因素。
我们招募了 92 名（43 名男性/49 名女性）患者，这些患者在接受经蝶窦手术前入住神经外科病房，并将他们与无继发性骨质疏松症和垂体疾病的对照组个体进行了比较。我们在术前胸部 X 射线图像上进行了 VF 评估，并收集了生化、人口统计学和临床数据。
我们发现肢端肥大症患者的 VFs 患病率明显高于对照组（33.7%比 0.001）。在肢端肥大症和 VFs 患者中，12 例（38.7%）有多处 VFs，5 例（16.1%）有中度/重度 VFs。有 VFs 的患者的随机血清生长激素（GH）水平高于无 VFs 的患者（P=0.03），但胰岛素样生长因子-1（IGF-1）（P=0.07）和 IGF-1/上正常范围比值（P=0.08）没有差异。有 VFs 的肢端肥大症患者的游离 3,5,3'-三碘甲状腺原氨酸水平略低于无 VFs 的患者（P=0.05）。在多因素逻辑回归分析中，GH 与 VFs 的风险独立相关（P=0.003）。预测 VFs 的术前血清 GH 截断值为 12ng/mL。
我们首次报道了近期诊断为肢端肥大症患者中 VFs 的高患病率。因此，我们可以假设 VFs 是肢端肥大症的早期现象，与 GH 水平有关。在诊断肢端肥大症时，应包括 VF 评估。
